GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
S 1
SENATE BILL 160
Short Title: Respiratory Care Modernization Act. (Public)
Sponsors: Senator Burgin (Primary Sponsor).
Referred to: Rules and Operations of the Senate
February 26, 2025
*S160 -v-1*
A BILL TO BE ENTITLED 1
AN ACT TO UPDATE THE GENERAL STATUTES OF NORTH CAROLINA GOVE RNING 2
THE PRACTICE OF RESPIRATORY CARE TO BETTER REFLECT THE CHANGES IN 3
EDUCATION, EXPERIENCE, AND PRACTICE OF THE PROFESSION IN ORDER TO 4
ENHANCE THE HEALTH A ND WELFARE OF NORTH CAROLINA CITIZENS. 5
Whereas, it is the intention of the North Carolina General Assembly to promote the 6
health and welfare of the citizens of this State; and 7
Whereas, the COVID-19 pandemic has placed increasing demands on all health care 8
professionals; and 9
Whereas, it is the intention of the North Carolina General Assembly that statutes 10
governing the profession of respiratory care reflect current practices, improvements, and other 11
developments that have occurred in the profession; and 12
Whereas, the current statutory language does not fully encompass current practices, 13
improvements, and other developments; Now, therefore, 14
The General Assembly of North Carolina enacts: 15
SECTION 1. Article 38 of Chapter 90 of the General Statutes reads as rewritten: 16
"Article 38. 17
"Respiratory Care Practice Act. 18
… 19
"§ 90-648. Definitions. 20
The following definitions apply in this Article: 21
(1) Advanced respiratory care practitioner (ARCP). – A person licensed in this 22
State who has gained additional specialized knowledge, skills, and experience 23
through a postgraduate advanced practice respiratory therapy program of 24
study as defined by the Board and is authorized to perform advanced 25
respiratory therapy practices under the supervision of a physician licensed to 26
practice medicine in accordance with Article 1 of this Chapter. 27
(1a) Advanced respiratory care procedures. – Procedures that require additional 28
competency training in accordance with rules adopted by the Board. 29
(1)(1b) Board. – The North Carolina Respiratory Care Board. 30
(2) Diagnostic testing. – Cardiopulmonary procedures and tests performed on the 31
written order of a physician licensed under Article 1 of this Chapter that 32
provide information to the physician to formulate a diagnosis of the patient's 33
condition. The tests and procedures may include pulmonary function testing, 34
electrocardiograph testing, cardiac stress testing, and sleep related testing. 35 General Assembly Of North Carolina Session 2025
Page 2 Senate Bill 160-First Edition
(3) Direct supervision. – The authority and responsibility to direct the 1
performance of activities as established by policies and procedures for safe 2
and appropriate completion of services. 3
(3a) Endorsement. – A designation issued by the Board recognizing the person 4
named on the endorsement as having met the requirements to perform 5
advanced respiratory care procedures as defined by rules adopted by the 6
Board. 7
(4) Individual. – A human being. 8
(4a) Invasive diagnostic and therapeutic procedure. – Any test or treatment that 9
uses instruments to cut, puncture, or otherwise enter the body. 10
(5) License. – A certificate issued by the Board recognizing the person named 11
therein as having met the requirements to practice respiratory care as defined 12
in this Article.Article as a respiratory care practitioner or advanced respiratory 13
care practitioner. 14
(6) Licensee. – A person who has been issued a license under this Article. 15
(7) Medical director. – An appointed physician who is licensed under Article 1 of 16
this Chapter and a member of the entity's medical staff, and who is granted 17
the authority and responsibility for assuring and establishing policies and 18
procedures and that the provision of such is provided to the quality, safety, 19
and appropriateness standards as recognized within the defined scope of 20
practice for the entity. 21
(8) Person. – An individual, corporation, partnership, association, unit of 22
government, or other legal entity. 23
(9) Physician. – A doctor of medicine An individual licensed to practice medicine 24
by the State of North Carolina in accordance with Article 1 of this Chapter. 25
(9a) Practice of advanced practice respiratory therapy. – The scope of practice as 26
determined by the supervising physician at the practice level in any health care 27
setting authorized by the supervising physician and the Board. It shall not 28
include (i) medical diagnosis; (ii) prescribing; (iii) interpretation of medical 29
diagnostic imaging studies; (iv) final interpretation of sleep studies or 30
pulmonary function tests; (v) surgery; (vi) delivery of anesthesia; and (vii) 31
ordering or performing diagnostic and therapeutic procedures that are more 32
than minimally invasive and have known complications that involve serious 33
injury and death, unless a physician is physically present to supervise the 34
advanced practice respiratory care therapist or the procedure is provided 35
pursuant to subdivision (10) of this section. The advanced respiratory care 36
practitioner may perform acts, tasks, or functions in any health care setting for 37
which the physician is responsible, and which are as follows: 38
a. Related to the care of persons with problems affecting the 39
cardiovascular and cardiopulmonary systems. 40
b. Delegated by a supervising physician. 41
c. Appropriate to the advanced respiratory care practitioner's education, 42
training, experience, and level of competence. 43
(10) Practice of respiratory care. – As defined by the written order of a physician 44
licensed under Article 1 of this Chapter, Chapter for respiratory care 45
practitioners, the observing and monitoring of signs and symptoms, general 46
behavior, and general physical response to respiratory care treatment and 47
diagnostic testing, including the determination of whether such signs, 48
symptoms, reactions, behavior, or general response exhibit abnormal 49
characteristics, and the performance of diagnostic testing and therapeutic 50
application of: 51 General Assembly Of North Carolina Session 2025
Senate Bill 160-First Edition Page 3
a. Medical gases, humidity, and aerosols including the maintenance use 1
of associated apparatus, respiratory care equipment, except for the 2
purpose of anesthesia. 3
b. Pharmacologic agents related to respiratory care procedures, including 4
those agents necessary to perform hemodynamic monitoring. 5
c. Mechanical or physiological ventilatory support. 6
d. Cardiopulmonary resuscitation and maintenance of natural airways, 7
the insertion and maintenance of artificial airways under the direct 8
supervision of a recognized medical director in a health care 9
environment which identifies these services within the scope of 10
practice by the facility's governing board. 11
e. Hyperbaric oxygen therapy. 12
f. New and innovative respiratory care and related support activities in 13
appropriately identified environments and under the training and 14
practice guidelines established by the American Association of 15
Respiratory Care. 16
The term also means the interpretation and implementation of a 17
physician's written or verbal order pertaining to the acts described in 18
this subdivision. 19
(11) Respiratory care. – As defined by the written order of a physician licensed 20
under Article 1 of Chapter 90, the treatment, management, diagnostic testing, 21
and care of patients with deficiencies and abnormalities associated with the 22
cardiopulmonary system. 23
(12) Respiratory care practitioner. – A person who has been licensed by the Board 24
to engage in the practice of respiratory care. 25
(12a) Serious injury. – An injury that creates a substantial risk of impairment of any 26
bodily function that requires immediate medical attention or hospitalization. 27
(12b) Supervising physician. – A physician with the competencies and authority to 28
supervise advanced respiratory care practitioners. 29
(13) Support activities. – Procedures Tasks that do not require formal academic 30
training, including the delivery, setup, and routine maintenance and repair of 31
apparatus. respiratory care equipment. The term also includes giving 32
instructions on the use, fitting, and application of apparatus, respiratory care 33
equipment but does not include therapeutic evaluation and 34
assessment.assessment for an individual patient as defined in rules adopted by 35
the Board. 36
"§ 90-649. North Carolina Respiratory Care Board; creation. 37
(a) The North Carolina Respiratory Care Board is created. The Board shall consist of 10 38
members as follows: 39
(1) Two members shall be respiratory care practitioners. 40
(2) Four members shall be physicians licensed to practice in North Carolina, and 41
whose primary practice is Pulmonology, Anesthesiology, Critical Care 42
Medicine, or whose specialty is Cardiothoracic Disorders. 43
(3) One member shall represent the North Carolina Hospital Association. 44
(4) One member member, who is a resident of this State, shall represent the North 45
Carolina Association of Atlantic Coast Medical Equipment Services.Services 46
Association. 47
(5) Two members shall represent the public at large. 48
… 49
"§ 90-650. Appointments and removal of Board members; terms and compensation. 50
(a) The members of the Board shall be appointed as follows: 51 General Assembly Of North Carolina Session 2025
Page 4 Senate Bill 160-First Edition
… 1
(7) The North Carolina Association of Atlantic Coast Medical Equipment 2
Services Association shall appoint the member described in 3
G.S. 90-649(a)(4). 4
… 5
"§ 90-652. Powers and duties of the Board. 6
The Board shall have the power and duty to: 7
(1) Determine the qualifications and fitness of applicants for licensure, renewal 8
of licensure, and reciprocal licensure. The Board shall, in its discretion, 9
investigate the background of an applicant to determine the applicant's 10
qualifications with due regard given to the applicant's competency, honesty, 11
truthfulness, and integrity. The State Bureau of Investigation may provide a 12
criminal record check to the Board for a person who has applied for a license 13
through the Board. The Board shall provide to the State Bureau of 14
Investigation, along with the request, the fingerprints of the applicant, any 15
additional information required by the State Bureau of Investigation, and a 16
form signed by the applicant consenting to the check of the criminal record 17
and to the use of the fingerprints and other identifying information required 18
by the State or national repositories. Investigation. The applicant's fingerprints 19
shall be used by the State Bureau of Investigation for a search of the State's 20
criminal history record file, and the State Bureau of Investigation shall 21
forward a set of the fingerprints to the Federal Bureau of Investigation for a 22
national criminal history check. The Board shall keep all information pursuant 23
to this subdivision privileged, in accordance with applicable State law and 24
federal guidelines, and the information shall be confidential and shall not be a 25
public record under Chapter 132 of the General Statutes. The Board shall 26
collect any fees required by the State Bureau of Investigation and shall remit 27
the fees to the State Bureau of Investigation for expenses associated with 28
conducting the criminal history record check. 29
… 30
(14) Establish and adopt rules defining the education and credential requirements 31
for persons seeking endorsement under this Article. 32
"§ 90-653. Licensure requirements; examination. 33
(a) Each applicant for licensure a respiratory care practitioner license under this Article 34
shall meet the following requirements:do all of the following: 35
(1) Submit a completed application as required by the Board.Board, which shall 36
include a form signed by the applicant consenting to the check of the 37
applicant's criminal record and to the use of the applicant's fingerprints and 38
other identifying information required by the State and national repositories. 39
(2) Submit any fees required by the Board. 40
(3) Submit to the Board written evidence, verified by oath, that the applicant has 41
successfully completed the minimal entry-level degree requirements of a 42
respiratory care education program as approved by the Commission for 43
Accreditation of Allied Health Educational Programs, or the Canadian 44
Council on on Accreditation for Respiratory Therapy Education.Care 45
(CoARC) or its successor by arranging for the applicant's respiratory care 46
education program to submit an official transcript confirming successful 47
completion of the respiratory care education program directly to the Board. 48
(4) Submit to the Board written evidence, verified by oath, that the applicant has 49
successfully completed the minimal requirements for Basic Cardiac Life 50 General Assembly Of North Carolina Session 2025
Senate Bill 160-First Edition Page 5
Support as recognized by the American Heart Association, the American Red 1
Cross, or the American Safety and Health Institute. 2
(5) Pass Submit to the Board written evidence, verified by oath, that the 3
entry-level applicant passed the examination requirements as defined by the 4
rules adopted by the Board given by the National Board for Respiratory Care, 5
Inc.Inc., or its successor, for entry-level respiratory care practitioners. 6
(b) At least three times each year, the Board shall cause the examination required in 7
subdivision (5) of subsection (a) of this section to be given to applicants at a time and place to be 8
announced by the Board. Any applicant who fails to pass the first examination may take 9
additional examinations in accordance with rules adopted pursuant to this Article. 10
(c) Each applicant for an advanced respiratory care practitioner license under this Article 11
shall do all of the following: 12
(1) Submit a completed application as required by the Board, including a form 13
signed by the applicant consenting to the check of the applicant's criminal 14
record and to the use of the applicant's fingerprints and other identifying 15
information required by the State and national repositories. 16
(2) Submit any fees required by the Board. 17
(3) Submit to the Board written evidence, verified by oath, that the applicant has 18
successfully completed the postgraduate degree requirements of respiratory 19
care education for the advanced practice respiratory therapist as approved by 20
the Commission on Accreditation for Respiratory Care (CoARC) or its 21
successor by arranging for the applicant's respiratory care education program 22
to submit an official transcript confirming successful completion of the 23
advanced respiratory care education program directly to the Board. 24
(4) Submit to the Board written evidence, verified by oath, that the applicant has 25
successfully completed the minimal requirements for Basic Cardiac Life 26
Support as recognized by the American Heart Association, the American Red 27
Cross, and the American Safety and Health Institute. 28
(5) Submit to the Board written evidence, verified by oath, that the applicant 29
passed the examination requirements as defined by Board rules pursuant to 30
this Article given by the National Board for Respiratory Care, Inc., or its 31
successor, for advanced-level respiratory care practitioners and defined by 32
Board rules pursuant to this Article. 33
(d) When issuing a license, the Board shall state the terms and conditions of use of the 34
license to the licensee. 35
… 36
"§ 90-660. Expenses; fees. 37
… 38
(b) All monies received by the Board pursuant to this Article shall be deposited in an 39
account for the Board and shall be used for the administration and implementation of this Article. 40
The Board shall establish fees in amounts to cover the cost of services rendered for the following 41
purposes: 42
(1) For an initial application, a fee not to exceed fifty dollars ($50.00). 43
(2) For examination or reexamination, a fee not to exceed two hundred dollars 44
($200.00). 45
… 46
(6) For a license with a provisional or temporary endorsement, a fee not to exceed 47
fifty dollars ($50.00). 48
… 49
"§ 90-661. Requirement of license. 50
It shall be unlawful for any person who is not currently licensed under this Article to: 51 General Assembly Of North Carolina Session 2025
Page 6 Senate Bill 160-First Edition
(1) Engage in the practice of respiratory care. 1
(2) Use the title "respiratory care practitioner".practitioner" or "advanced 2
respiratory care practitioner." 3
(3) Use the letters "RCP", "RTT", "RT", "ARCP", or any facsimile or 4
combination in any words, letters, abbreviations, or insignia. 5
(4) Imply orally or in writing or indicate in any way that the person is a respiratory 6
care practitioner practitioner, advanced respiratory care practitioner, or is 7
otherwise licensed under this Article. 8
(5) Employ or solicit for employment unlicensed persons to practice respiratory 9
care. 10
… 11
"§ 90-667. Confidentiality of Board investigative information. 12
(a) All records, papers, investigative information, and other documents containing 13
information that the Board, its members, or its employees possess, gather, or receive as a result 14
of investigations, inquiries, assessments, or interviews conducted in connection with a licensing 15
complaint, appeal, assessment, potential impairment matter, or disciplinary matter shall not be 16
considered public records within the meaning of Chapter 132 of the General Statutes and are 17
privileged, confidential, not subject to discovery, subpoena, or any means of legal compulsion 18
for release to anyone other than the Board, its employees, or consultants involved in the 19
application for license, impairment assessment, or discipline of the licensee, except as provided 20
in subsection (b) of this section. For the purposes of this section, "investigative information" 21
means investigative files and reports, information relating to the identity and report of a physician 22
or other professional performing an expert review for the Board, and any of the Board's 23
investigative materials that are not admitted into evidence. 24
(b) The Board shall provide the licensee or applicant for license access to all information 25
in its possession that the Board intends to offer into evidence at the licensee's or applicant's 26
hearing. The Board shall not be required to produce (i) information subject to attorney-client 27
privilege or (ii) investigative information that the Board will not offer into evidence and is related 28
to advice, opinions, or recommendations of the Board's staff, consultants, or agents. 29
(c) Any licensee's notice of statement of charges, notice of hearing, and all information 30
contained in those documents shall be public records under Chapter 132 of the General Statutes. 31
(d) If the Board, its employees, or its agents possess investigative information indicating 32
a crime may have been committed, the Board may report the information to the appropriate law 33
enforcement agency or district attorney of the district in which the offense was committed. The 34
Board shall cooperate with and assist any law enforcement agency or district attorney conducting 35
a criminal investigation or prosecution of a licensee by providing relevant information. This 36
information shall be confidential under G.S. 132-1.4 and shall remain confidential after 37
disclosure to a law enforcement agency or district attorney. 38
(e) All licensees shall self-report to the Board any of the following within 30 days of their 39
arrest or indictment: 40
(1) Any felony or arrest or indictment. 41
(2) Any arrest for driving while impaired or driving under the influence. 42
(3) Any arrest or indictment for the possession, use, or sale of any controlled 43
substance. 44
(f) The Board, its members, or its staff may release confidential information concerning 45
the denial, annulment, suspension, or revocation of a license to any other health care licensing 46
board in this State, other state, or country, or authorized Department of Health and Human 47
Services personnel who are charged with the enforcement or investigative responsibilities of 48
licensure. If the Board releases this confidential information, the Board shall notify and provide 49
a summary of the information to the licensee within 60 days after the information is transmitted. 50
The licensee may make a written request that the Board provide the licensee a copy of all 51 General Assembly Of North Carolina Session 2025
Senate Bill 160-First Edition Page 7
information transmitted within 30 days of receiving notice of the initial transmittance. The Board 1
shall not provide the information if the information relates to an ongoing criminal investigation 2
by any law enforcement agency or authorized Department of Health and Human Services 3
personnel with enforcement or investigative responsibilities. 4
(g) Notwithstanding the provisions of this section, the Board shall withhold the identity 5
of a patient, including information relating to dates and places of treatment, or any other 6
information that would tend to identify the patient, in any proceeding, record of a hearing, and in 7
the notice of charges against any licensee, unless the patient or the patient's representative 8
expressly consents to the public disclosure. 9
"§ 90-668. Limitations on advanced respiratory care practitioners. 10
(a) Individuals who are licensed under this Article as advanced respiratory care 11
practitioners may use the title "advanced respiratory care practitioner." Individuals who hold 12
themselves out as advanced respiratory care practitioners without being licensed are in violation 13
of this Article. 14
(b) Individuals who are licensed under this Article as advanced respiratory care 15
practitioners may practice advanced respiratory care under the supervision of a physician 16
licensed under Article 1 of this Chapter and within the scope of rules adopted by the Board." 17
SECTION 2. The North Carolina Respiratory Care Board shall adopt rules to 18
implement and administer the provisions of this act no later than October 1, 2025. 19
SECTION 3. Section 1 of this act becomes effective on October 1, 2025. Except as 20
otherwise provided, this act is effective when it becomes law. 21